Experience of diagnosis and treatment of urethral distortion after hypospadias surgery misdiagnosed as urethra diverticulum-like dilatation
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摘要: 目的 通过尿道下裂术后尿道扭曲误诊为尿道憩室样扩张的病例分析，探讨尿道扭曲的诊断、治疗及预防。方法 回顾性分析2020年1月—2023年1月天津市儿童医院收治的尿道下裂术后尿道憩室样扩张的11例患儿的临床资料，包括患儿的身高、体重、合并畸形、前期手术信息和本次手术信息。患儿年龄2~6岁，其中7例术中证实为尿道扭曲，并非尿道憩室样扩张。结果 手术采用尿道与白膜间断缝合固定，尿道周围筋膜或Buck筋膜覆盖的方法。术后随访5个月~3年，7例尿道扭曲均痊愈，有2例出现尿道瘘，再次手术治愈。结论 尿道扭曲是尿道下裂尿道成形术后比较少见的并发症，临床易误诊为尿道憩室样扩张，再次手术固定尿道及尿道周围筋膜或BUCK筋膜覆盖是治疗尿道扭曲最为有效的方法。Abstract: Objective The diagnosis, treatment, and prevention of urethral distortion were discussed through the analysis of cases misdiagnosed as urethra diverticulum-like dilatation after hypospadias surgery.Methods The clinical data of 11 children with urethra diverticulum-like dilatation after hypospadias surgery from January 2020 to January 2023 were retrospectively analyzed, including height, weight, combined malformations, information of previous operation, and information about the operation during this hospitalization. The patients ranged in age from 2 to 6 years, and 7 of them had urethral distortion instead of urethra diverticulum-like dilatation.Results The operation was performed by fixing the urethra and tunica albuginea through intermittent suture, and covering the periurethral fascia or Buck's fascia. After follow-up for 5 months to 3 years, all 7 cases of urethral distortion were cured. Urethral fistula occurred in 2 cases and was cured by re-operation.Conclusion Urethral distortion is a rare complication after hypospadias urethroplasty, which is easily misdiagnosed as urethra diverticulum-like dilatation. Re-operation to fix the urethra and cover periurethral fascia or Buck's fascia is the most effective treatment for urethral distortion.
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Key words:
- hypospadias /
- urethral distortion /
- urethra diverticulum-like dilatation /
- diagnosis /
- treatment
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表 1 7例尿道扭曲患儿基本信息
例序 初次就诊年龄/岁 身高/cm 体重/kg 合并畸形 1 3 92 13.3 双侧隐睾，双侧斜疝 2 1 80 9.9 阴茎阴囊转位 3 2 103 16.6 - 4 1 74 8.8 双上腔静脉 5 3 94 12.4 - 6 4 114 20.5 双侧隐睾，右侧鞘膜积液 7 4 105 16.3 双侧隐睾，阴茎阴囊转位 
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表 2 7例尿道扭曲患儿手术信息
手术信息 例1 例2 例3 例4 例5 例6 例7 前期手术 手术方式 Duckett+Duplay Duckett+Duplay Duckett+Duplay Duckett+Duplay Byars Byars Byars 手术年龄/岁 3 1 2 1 3 4 4 尿道成型长度/cma) 4.0+1.5 3.5+1.5 4+1.5 3+1 4.5 6 5 并发症 尿道口狭窄 尿道瘘 尿道瘘 尿道瘘 尿道瘘
阴茎头裂开尿道瘘 尿道瘘 本次手术 手术年龄/岁 6 2 2 3 6 5 5 临床症状 排尿局部隆起 排尿局部隆起 排尿局部隆起，尿流花洒样改变 排尿局部隆起 排尿局部隆起 排尿局部隆起 排尿局部隆起，尿流花洒样改变 手术方式 尿道切开、尿道成形尿道周围筋膜覆盖 尿道切开、尿道成形
尿瘘修补
尿道周围筋膜覆盖尿道瘘修补
尿道外口切开
尿道周围筋膜覆盖尿道瘘修补
Buck筋膜覆盖尿道瘘修补
Buck筋膜覆盖尿道瘘修补
Buck筋膜覆盖尿道瘘修补
Buck筋膜覆盖
尿道口背切术后效果 改善 改善 改善 改善 改善 改善 改善 并发症 尿道瘘b) 无 无 无 无 尿道瘘b) 无 注：a)2种术式及对应的重建尿道的长度；b)后期行尿道瘘修补术，痊愈。
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[1] Chen MJ, Karaviti LP, Roth DR, et al. Birth prevalence of hypospadias and hypospadias risk factors in newborn males in the United States from 1997 to 2012[J]. J Pediatr Urol, 2018, 14(5): 425.e1-425.e7. doi: 10.1016/j.jpurol.2018.08.024
[2] 宋宏程, 白继武, 黄澄如, 等. 尿道下裂术后尿道憩室样扩张的处理与预防[J]. 中华小儿外科杂志, 2007, 28(10): 528-530. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHXE200710019.htm
[3] Zhang Y, Chao M, Zhang WP, et al. Using Buck's fascia as an integral covering in urethroplasty to restore the anatomical structure of the penis in one-stage hypospadias repair: a multicenter Chinese study comprising 1, 386 surgeries[J]. Front Pediatr, 2021, 9: 695912. doi: 10.3389/fped.2021.695912
[4] 石浩宇, 黄立渠, 郭云飞. 利用横断后尿道板组织修复近段型尿道下裂的术式研究进展[J]. 临床小儿外科杂志, 2022, 21(1): 24-29. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXR202201006.htm
[5] Vallasciani S, Berrettini A, Nanni L, et al. Observational retrospective study on acquired megalourethra after primary proximal hypospadias repair and its recurrence after tapering[J]. J Pediatr Urol, 2013, 9(3): 364-367. doi: 10.1016/j.jpurol.2012.05.005
[6] Yucel S, Guntekin E, Kukul E, et al. Comparison of hypospadiac and normal preputial vascular anatomy[J]. J Urol, 2004, 172(5 Pt 1): 1973-1976;discussion 1976.
[7] Zhou W, Li CP, Xia F, et al. Application of a free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering for the single-stage repair of severe hypospadias[J]. Front Surg, 2022, 9: 1047104.
[8] Retik AB, Atala A. Complications of hypospadias repair[J]. Urol Clin North Am, 2002, 29(2): 329-339. doi: 10.1016/S0094-0143(02)00026-5
[9] Shukla AR, Patel RP, Canning DA. Hypospadias[J]. Urol Clin North Am, 2004, 31(3): 445-460, ⅷ. doi: 10.1016/j.ucl.2004.04.020
[10] Baba AA, Wani SA, Bhat NA, et al. Buck's fascia repair with glanuloplasty in hypospadias surgery: a simple approach with excellent outcome[J]. J Pediatr Urol, 2017, 13(6): 633.e1-633.e5. doi: 10.1016/j.jpurol.2017.06.015
[11] Snodgrass W, Macedo A, Hoebeke P, et al. Hypospadias dilemmas: a round table[J]. J Pediatr Urol, 2011, 7(2): 145-157. doi: 10.1016/j.jpurol.2010.11.009
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